THE ASSOCIATION OF RADIOGRAPHICALLY DETECTED VERTEBRAL FRACTURES WITHBACK PAIN AND FUNCTION - A PROSPECTIVE-STUDY

Background: Vertebral fractures are a hallmark of postmenopausal osteo porosis and an important end point in trials of osteoporosis treatment , but the clinical significance of these fractures remains uncertain. Objective: To determine the association of new vertebral fractures wit h back pain and back-related functional limitation in older women. Des ign: Prospective observational study. Setting: Multicenter Study of Os teoporotic Fractures. Participants: 7223 white women aged 65 years and older. Measurements: Lateral spine radiographs were obtained at basel ine and at a follow-up examination an average of 3.7 years later. Prev alent and incident radiographic vertebral fractures were assessed by q uantitative morphometry. Frequency and severity of back pain, disabili ty in doing six activities involving the back, and days of bed rest an d days of limited activity due to back pain were assessed annually by questionnaire during follow-up. Results: Among women without a vertebr al fracture at baseline, those with at least one incident vertebral fr acture were more likely to have increased back pain (odds ratio [OR], 2.4 [95% CI, 1.7 to 3.3]) and back disability (OR, 2.6 [CI, 1.9 to 3.7 ]) and at least 1 day of bed rest due to back pain (OR, 6.7 [CI, 4.4 t o 10.2]) and 7 days of limited activity due to back pain per year (OR, 3.8 [CI, 2.7 to 5.0]). Among women with a fracture at baseline, those with an incident vertebral fracture also had a greater risk for incre ased back pain (OR, 2.0 [CI, 1.4 to 2.8]) and back disability (OR, 2.2 [CI, 1.5 to 3.1]) and at least 1 day of bed rest (OR, 7.9 [CI, 4.9 to 12.9]) and 7 days of limited activity per year (OR, 3.5 [CI, 2.4 to 5 .0]). Women with incident fracture had about 10 additional limited-act ivity days and 1 to 2 days of bed rest per year. New vertebral fractur es that did not come to medical attention were associated with increas ed back pain and functional limitation. Conclusion: New vertebral frac tures, even those not recognized clinically, are associated with subst antial increases in back pain and functional limitation due to back pa in in older white women. Prevention of new vertebral fractures should reduce the burden of back pain and functional limitation in women with vertebral osteoporosis.